Stroke victim's recovery rare, astonishing

Thursday

Two years ago, Barbara Collard suffered one of the most severe strokes ever seen by doctors at Massachusetts General Hospital.

About two years ago, Barbara Collard suffered one of the most severe strokes ever seen by doctors at Massachusetts General Hospital.

But against the odds, the New Bedford grandmother has made an almost complete recovery — an event so remarkable that her case story has been accepted for publication in a neurological research journal.

It began one morning in July 2008.

Collard woke up feeling "out of sorts" that Sunday, the date of a big family get-together. The 67-year-old mother of five daughters had to miss the party celebrating the birthdays of three of her nine grandchildren. Instead, she spent the day in bed.

Two days later at work in her office at Bristol Community College, where she was secretary to the school's architectural engineer, she felt better. But by mid-morning, her arms began shaking. A few moments later, she collapsed.

EMTs rushed her to the emergency room at Fall River's Charlton Memorial Hospital where, based on her symptoms, she was quickly evaluated as "code green" — the victim of an acute stroke — and immediately airlifted to Mass. General in Boston.

The stroke team at MGH, including neurologists Dr. Natalia Rost and Dr. James Rabinov, found Collard unresponsive to neurological tests; imaging showed the stroke had occurred in the brain stem — a life-threatening condition — causing serious damage to her brain.

"An arterial blood clot had formed in the base of the brain stem," said Rabinov in a hospital Web story on Collard's case. Rabinov is an interventional neuroradiologist in the Massachusetts General Hospital Vascular Center.

"This area of the brain controls awareness and motor function. An embolic stroke in this part of the brain can be fatal. We had to remove the clot quickly."

Collard's stroke was caused by a blockage in the left vertebral artery of the neck. Imaging showed a clot in the basilar artery of the brain, which supplies the brain stem. An intravenous clot-reducing drug would have been available for Collard's treatment, but only if administered within three hours of the onset of the stroke. Since more time had by now elapsed, the doctors' only option was to apply the drug directly to the clot or to remove it, a delicate surgical procedure. And Collard was clinging to life.

"We were not sure if she would have much quality of life, but her situation was not hopeless," Rabinov said in the MGH story.

After consulting Richard Collard, Barbara's husband of 49 years, and their daughters, all agreed to the procedure, which was to catheterize the vertebral and basilar arteries and, using a variety of techniques including the clot-dissolving medicine, restore blood flow to the brain.

The decision was both "medical and emotional," said Rabinov, who performed the surgery, "but the family chose to give her every possible chance."

Collard's stroke was one of the most severe MGH had ever seen, according to Rost, who worked alongside Rabinov throughout the surgery. The hospital reports that brain scans prior to Collard's procedure showed that most of the neurons in the brain stem appeared dead, usually a poor indication for recovery. But follow-up MRIs showed seemingly dead tissue had recovered once blood flow was restored, an extremely rare outcome.

"I know I'm very fortunate," says Collard. "Everything was in place for a happy outcome. Everyone did exactly the right thing at exactly the right time, and I had the best of care at every step. Plus, I had a lot of prayers coming my way; someone was definitely looking out for me."

The day after her stroke, Collard began to regain strength very rapidly, and after 16 days at MGH — seven in the Neurointensive Care Unit — she was transferred to the Rehabilitation Hospital of Cape Cod and the Islands in Sandwich.

Though she had no memory of what happened from the moment of her collapse at BCC until after her operation, Collard came out of surgery determined to reclaim her life. But the battle would be uphill. The stroke had paralyzed Collard's entire right side. At first, she couldn't walk or talk.

"I was determined that I could do anything I could do before," she says. "All I had to do was exactly what my therapists told me to do."

With her husband at her side, Collard completed her therapy at Rehabilitation Hospital and returned home after three weeks. Today, thanks to frequent rehab sessions for over a year, "I am through with therapy and better than 95 percent cured," she says. "I have no restrictions on my activities. I can knit and sew. I can walk and talk. Most of all, I can play with my grandchildren."

Collard's recovery from such a devastating brain-stem stroke is considered a medical marvel.

"I didn't recognize her the first time she came to my clinic for a follow-up appointment," Rost said in the MGH report. "I was in the waiting room expecting someone in a wheelchair, and she was just standing there smiling at me."

Today, says Rost, a neurologist with the Mass. General Stroke Service, "I agree entirely with Barbara's own assessment of her progress since. She is better than 95 percent improved."

Stroke is one of the leading causes of serious, life-threatening disability in the United States, according to the Southcoast Hospitals Group. Approximately 600,000 new strokes are reported each year — one every 45 seconds. Stroke claims a life every 3.3 minutes.

Strokes can be of two types: a hemorrhage that occurs when a blood vessel ruptures or leaks blood into the brain; or a blockage that occurs in a brain vessel.

The latter is called ischemic and is the kind Collard experienced. Just as a heart attack starves heart cells of oxygen, a stroke or "brain attack" cuts off the supply of life-giving oxygen to brain cells, usually resulting in disability or death.

Quick action is vital, according to the American Heart Association. Within three hours of first symptoms, intravenous treatment might work; any later, as in Collard's case, more radical intervention might be required.

Because her response to the procedures at MGH and her rapid recovery have been so unusual, Collard's case study has been accepted for publication in the Journal of Neurointerventional Surgery, a quarterly on scientific research and literature.

The MGH Web site explains of Collard's recover, "We postulate that her blood vessels helped her out with some collateral circulation. It may have allowed a small amount of oxygen supply to the ischematic tissue near the blockage. By opening the blockage, some of the injured tissue could recover."

Sending a local stroke patient elsewhere for treatment is not routine, says neurologist Dr. Bruce Abbott.

"Not all patients who suffer a stroke in SouthCoast automatically need to be airlifted to Boston or to any other big-city hospital," says Abbott, medical director of the Stroke Committee of Southcoast Hospitals Group.

"Through telemedicine conferencing, we are able not only to bring treatment to the patient where the patient is, but also to seek consultation and assessment from other experts at other stroke centers in real time."

Featured recently in a report on National Public Radio, the Telestroke program provides a direct link to Massachusetts General Hospital with a monitor and two-way video communication.

All three Southcoast hospitals (Charlton Memorial, St. Luke's in New Bedford, and Tobey in Wareham) provide Telestroke services and are designated Primary Stroke Service providers by the Massachusetts Department of Public Health.

To qualify as a Primary Stroke Service, DPH requires every center to have a highly trained neurological staff that follows written protocols and provides care 24 hours a day, seven days a week. Laboratory and neurological services must be at hand, along with quality assessment and improvement programs, on-going training for all stroke staff and an extensive community education plan.

More information on strokes is available at www.southcoast.org/stroke or from the American Stroke Association at www.strokeassociation.org or 1-888-4-STROKE (888-478-7653).

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